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E-Cig Use Increases Risk of Beginning Tobacco Cigarette Use in Young Adults, Study Says

Young adults who use electronic cigarettes (e-cigarettes) are more than four times as likely to begin smoking tobacco cigarettes within 18 months as their peers who do not vape, according to new University of Pittsburgh research. The findings demonstrate that e-cigarettes are serving as a gateway to traditional smoking, contrary to their purported value as a smoking cessation tool.

Published in the American Journal of Medicine, the study is the first nationally representative survey that followed for more than a year people 18 to 30 years old who were initially nonsmokers.

"Early evidence on the potential value of e-cigarettes for cessation or reduction of cigarette smoking has been mixed," says lead author Brian A. Primack, MD, PhD, director of Pitt's Center for Research on Media, Technology and Health; dean of Pitt's Honors College; and a professor of medicine, pediatrics, and clinical and translational science at Pitt's School of Medicine. "Our study finds that in nonsmokers, e-cigarettes make people more likely to start smoking. This supports policy and educational interventions designed to decrease the use of e-cigarettes among nonsmokers."

The team analyzed a survey of U.S. adults who were randomly selected in March 2013 to complete a questionnaire about their tobacco use. Eighteen months later, in October 2014, 915 participants who said they had never smoked cigarettes completed a follow-up survey.

The team then applied "weights" to the survey results by over- and underemphasizing the answers of the survey participants in order to arrive at findings that would be more representative of the true make-up of the U.S. population. For example, only 14.2% of those surveyed were Hispanic, so the team overemphasized their answers so that the weighted sample and final results were 19.7% Hispanic.

The final, weighted survey results showed that 11.2% of participants—none of whom had ever smoked when they completed the initial questionnaire—had started smoking tobacco cigarettes. Of participants who said they vaped e-cigarettes in the first questionnaire, 47.7% had started smoking cigarettes 18 months later, compared with 10.2% of those who did not use e-cigarettes. Without the survey weights to make the sample representative of the U.S. population, 37.5% of e-cigarette users had started smoking cigarettes 18 months later, compared with 9% of those who didn't use e-cigarettes.

More research will be needed to determine why e-cigarettes increase the risk of someone transitioning to tobacco cigarettes, but Primack notes that several factors are likely at play, including that using e-cigarettes mimics the behavior of smoking traditional cigarettes, the sweet vape is a gentle introduction to smoking harsher tobacco, and the build-up of nicotine addiction could lead e-cigarette users to seek out more nicotine-packed tobacco cigarettes.

"Young adulthood is an important time when people establish whether they use tobacco or not," Primack says. "Our findings suggest that clinicians who treat e-cigarette users should counsel them both about their potential for harm and about the high risk of transitioning to tobacco cigarettes among initial nonsmokers."